Pt. 2: Stress Incontinence

Last month I discussed urge urinary incontinence and its treatments. Urge incontinence is just one type of urinary incontinence, and it is characterized by a sudden, strong “urge” to urinate. For a more complete discussion of this type of incontinence, please see our article from November 2015, entitled “Urge Incontinence.” This month I will go over the other main type of urinary incontinence: stress incontinence.

Stress incontinence is the most common type of urinary incontinence among younger women, especially women ages 45 to 49 years. Women who have stress incontinence leak urine with increased intra-abdominal pressure. Activities that increase intra-abdominal pressure include laughing, coughing, sneezing, running, or jumping. This type of incontinence is caused by weakening of the pelvic floor muscles and tissue. These muscles can be damaged during childbirth, especially with a vaginal delivery.

The strongest risk factor for developing incontinence is obesity. Obese women are three times more likely to develop urinary incontinence than non-obese women. Increased BMI causes increases in intra-abdominal pressure, placing these individuals at greater risk of developing stress incontinence.

Childbirth is another risk factor for developing stress incontinence, and the risk increases as you have more children. Studies have shown that women who have had vaginal deliveries develop stress incontinence at a higher rate than women who delivered via C-section; however, a cesarean delivery does not necessarily protect women from urinary incontinence. Smoking is another risk factor for developing stress incontinence. Risk for stress incontinence also increases with age.

If you have problems with leaking urine, the first step is to schedule an appointment with your physician so that he or she can evaluate and classify the type of urinary incontinence. Further evaluations may include laboratory testing, such as urinalysis, keeping a diary of your urinary incontinence symptoms, or urodynamic testing. Once your doctor knows the type of incontinence you have, a plan can be made to treat your condition.

Treatment for stress incontinence can range from physical therapy to surgery. For the most part, medications are not used to treat stress incontinence since it is often due to a structural issue. For this reason, physical therapy and surgery are more effective treatments.

Pelvic floor muscles exercises, or Kegels, are effective for all types of urinary incontinence. By tightening the muscles of the pelvic floor, muscle strength can be increased. When the pelvic floor muscles are strengthened, your muscles are better able to prevent urine from leaking. Your physician may give you a regimen for performing pelvic floor exercises because this therapy is most effective when performed consistently over the course of many months. If self-guided pelvic floor therapy is not effective for you, supervised pelvic floor therapy may be a better fit. This type of physical therapy is performed in a physician’s office where you practice pelvic floor exercises guided and instructed by a health professional.

If physical therapy is not sufficient, another treatment option is a continence pessary. A pessary is a flexible silicone device that goes inside the vagina. The device supports the neck of the bladder, helping to prevent urine leakage. Your doctor can evaluate if you are a candidate for a pessary and fit you for one in the office.

If other treatments are ineffective, there are different surgical options that are effective at reducing, or even eliminating, urinary incontinence. One surgery is called a colporrhaphy, or a vaginal wall repair. This surgery is especially effective if your symptoms of urinary incontinence are accompanied by a cystocele, or dropped bladder. Another surgery used to treat stress incontinence is an urethropexy, or transvaginal taping. This is an inpatient procedure that is performed vaginally. An incision is made between the urethra and the vagina, and a small sling is inserted that lifts the urethra and prevents urine leakage.

Urinary incontinence is a condition that affects millions of women, but it is not a condition you have to live with. Incontinence is a treatable condition that should be evaluated by a physician. Whether your incontinence is diagnosed as stress, urge, or mixed (a combination of stress and urge incontinence), there are a wide variety of treatments that can be used to improve your quality of life. Speak to your health care provider to discuss your options and do not let urinary incontinence keep you from living a full and active life.

Dr. Hardy practices obstetrics and gynecology at Atlantic Ob/Gyn with locations in Virginia Beach and Chesapeake. Please call 757-463-1234 or visit www.atlanticobgyn.com.

Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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